> ## Documentation Index
> Fetch the complete documentation index at: https://docs.getrivet.ca/llms.txt
> Use this file to discover all available pages before exploring further.
# PSQI — Pittsburgh Sleep Quality Index
> The 19-item self-report measure of sleep quality over the past month, with three components live-scored in Rivet.
The PSQI is the dominant clinical measure of sleep quality. You send it when
sleep is part of the formulation — depression with insomnia, generalized
anxiety with sleep onset trouble, trauma-related nightmares, CBT-I outcome
tracking, or a baseline against ISI for monitoring change.
Clients answer 19 items about their sleep over the past month. The original
PSQI also includes 5 partner-observer items (snoring, leg movements, apnea,
confusion) — Rivet uses the 19-item self-report subset, which is the
dominant configuration in clinical practice.
## What it measures
Sleep quality and disturbance across seven canonical components:
* Subjective sleep quality
* Sleep latency (how long to fall asleep)
* Sleep duration
* Habitual sleep efficiency (time asleep ÷ time in bed)
* Sleep disturbances (waking up, pain, bad dreams, breathing problems)
* Use of sleeping medication
* Daytime dysfunction (staying awake, low motivation)
The canonical algorithm rolls these seven component scores (each 0–3) into a
**Global PSQI** ranging 0–21.
## When to send it
* Intake for any client where sleep is in the picture
* Monthly or every-6-week monitoring during CBT-I or behavioural sleep work
* As a screening trigger — a poor Global score is the standard prompt for
ISI follow-up or sleep-specialist referral
* Pre/post for any intervention where sleep is the primary outcome
The 19 self-report items take 5–10 minutes. Most clients fill it out async
in the day or two before session — send it ahead and the result is on the
client's record when they arrive.
## Scoring and severity cutoffs
Three components are live-scored in the app:
| Component | Items | Range | Bands |
| ---------------------------- | ----------- | ----- | -------------------------------------------------------------------- |
| Subjective sleep quality | Item 9 | 0–3 | Very good / Fairly good / Fairly bad / Very bad |
| Sleep disturbances (raw sum) | Items 5b–5j | 0–27 | None / Mild / Moderate / Severe |
| Sleep medication use | Item 6 | 0–3 | Not in past month / Less than weekly / Once or twice / Three or more |
The remaining four components (sleep latency, sleep duration, sleep
efficiency, daytime dysfunction) and the Global PSQI score require
arithmetic that Rivet's scoring engine doesn't yet express live in-session —
banding continuous values, ratios with banding, chained band-then-sum-then-
band sequences. The structured answers are still captured in full; you copy
them out for note-taking or compute the Global score against the canonical
scoring sheet when you need it.
The University of Pittsburgh Sleep Research Group publishes the canonical
scoring sheet at sleep.pitt.edu. Three minutes to walk the seven
component formulas if you need the Global number for a referral letter.
## Cutoffs
* **Global PSQI > 5** → poor sleeper (Buysse 1989: sensitivity 89.6%,
specificity 86.5%)
* **Global PSQI > 8** → severe insomnia (Backhaus et al. 2002)
Item 5h ("have bad dreams") is flagged sensitive in the template so the
intake panel keeps the trauma-informed framing on the rest of the form.
## PSQI vs ISI
The PSQI describes sleep; the [ISI](/clinical-templates/screening/isi)
grades insomnia. Nineteen items across a month covering quality, how long
it takes to fall asleep, how long the client sleeps, how much of their
time in bed is spent asleep, what disturbs them, medication and daytime
effects — that breadth is why it's the instrument for characterising a
sleep complaint you don't yet understand, and why it picks up problems
that aren't insomnia at all.
The ISI is seven items over two weeks and produces one number, which makes
it the easier measure to repeat during treatment. A PSQI above 5 is a
sensible trigger to follow up with the ISI or refer on.
The practical cost of the PSQI is scoring. Three of its seven components
compute in session; the rest, and the global score, need the published
scoring sheet — the response exports in full so you have everything you
need to do that.
## Is it free to use?
**Yes.** The University of Pittsburgh Sleep Research Group permits free clinical, educational and non-commercial research use.
## Citation
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J.
(1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric
practice and research. *Psychiatry Research,* 28(2), 193–213.
Free for clinical, educational, and non-commercial research use per the
University of Pittsburgh Sleep Research Group.
## When not to use it
PSQI asks about the past month — it's not the right tool for acute sleep
disruption in a recent crisis. Use ISI when you want a 2-week window or a
faster outcome measure during active CBT-I. Use both together when sleep is
the primary treatment target and you want a longitudinal-quality and
severity pair.
## Related articles
7-item, 2-week window. The CBT-I outcome measure.
How in-session and async administration work.